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2012 Texas Medicaid Provider Procedures Manual

Children’s Services Handbook : 2. Medicaid Children’s Services Comprehensive Care Program (CCP) : 2.8 Personal Care Services (PCS) (CCP) : 2.8.2 Services, Benefits, and Limitations : 2.8.2.3 PCS Provided in Group Settings

2.8.2.3
PCS Provided in Group Settings
PCS may be provided in a provider/client ratio other than one-to-one. Only the time spent on direct PCS for each client may be billed. Total PCS billed for all clients cannot exceed the individual provider's total number of hours spent at the POS. PCS may be provided by more than one attendant to an individual client, or PCS may be provided to more than one client by one attendant. Settings in which providers can provide PCS in a provider/client ratio other than one-to-one include homes with more than one client needing PCS, foster homes, and independent living arrangements.
A PCS provider may provide PCS to more than one client over the span of the day as long as:
Example:
If the prior authorized PCS hours for Client A is four hours, Client B is six hours, and the actual time spent with both clients is eight hours, the provider must bill for the actual one-on-one time spent with each client, not to exceed the client’s prior authorized hours or total hours worked. It would be acceptable to bill four hours for Client A and four hours for Client B, or three hours for Client A and five hours for Client B. It would not be acceptable to bill five hours for Client A and three hours for Client B. It would be acceptable to bill ten hours if the individual person actually spent ten hours onsite providing prior authorized PCS split as four hours for Client A and six hours for Client B. A total of ten hours cannot be billed if the individual person worked only eight hours.

Texas Medicaid & Healthcare Partnership
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